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‘They did not have to burn my sister alive’: Causes and Distribution by State of Dowry Murder in India
Get PDFDowry, the money, goods, property, or gifts given by the bride’s family to the groom or his family at the time of marriage, is a common custom in South Asia. Although it is illegal to demand—or offer—a dowry in India, it is a nearly universal custom in many parts of the country. If, after marriage, a husband’s family feels that the wife’s dowry was insufficient, they may harass or inflict other forms of domestic violence on her to put pressure on her family to provide an additional dowry. At its most extreme, this violence may lead to the murder of the wife. An increase in dowry murders, commonly by immolation, in the 1980s and 1990s was reflected in important studies of the phenomenon and changes to the law to prevent the crime. Although the number of dowry murders has grown in succeeding decades, there have been few recent studies; rarer still is research from an all-India perspective. In this paper, I examine trends in and causes of murder for dowry and the related crimes of domestic violence. Prominent theories are tested for their ability to explain the incidence of murder for dowry. Dowry murders are concentrated in north India. Because the marriage alliance systems of the north differ from those of the south, the impact of Indian kinship systems is explored. The multi-generation or ‘joint’ family—nearly universal in India—has been found by Umar to be a common factor in many cases of dowry murder he studied. By contrast, Oldenburg has argued that changes in land tenure during British rule created individual property rights for men, leading to a preference for sons and the emergence of demands for dowry and, ultimately, dowry murder. Most case studies of dowry murder have been drawn from India’s larger cities; the impact of urbanisation is also studied. Economists have suggested structural factors, such as population growth, the economic value of women’s work, poverty, income inequality, and conspicuous consumption as possible causes driving domestic violence and murder for dowry. The institutional capacity of an Indian state to provide education, health, and enforcement of laws such as those prohibiting dowry is also examined. This study identifies five principal causes which explain nearly 80% of the variation in dowry murders at the level of individual Indian states: its prevailing kinship system, the prevalence of the joint family, the extent of women’s workforce participation, income inequality, and the institutional performance of a state
Association between initial opioid prescription diagnosis type and subsequent chronic prescription opioid use in Rhode Island: A population-based cohort study
Get PDFObjective To identify initial diagnoses associated with elevated risk of chronic prescription opioid use. Design Population-based, retrospective cohort study. Setting State of Rhode Island. Participants Rhode Island residents with an initial opioid prescription dispensed between 1 April 2019 and 31 March 2020. Primary outcome measure Subsequent chronic prescription opioid use, defined as receiving 60 or more days\u27 supply of opioids in the 90 days following an initial opioid prescription. Results Among the 87 055 patients with an initial opioid prescription, 3199 (3.7%) subsequently became chronic users. Patients who become chronic users tended to receive a longer days\u27 supply, greater quantity dispensed, but a lower morphine milligram equivalents on the initial opioid prescription. Patients prescribed an initial opioid prescription for diseases of the musculoskeletal system and connective tissue (adjusted OR (aOR): 5.9, 95% CI: 4.7 to 7.6), diseases of the nervous system (aOR: 6.3, 95% CI: 4.9 to 8.0) and neoplasms (aOR: 5.6, 95% CI: 4.2 to 7.5) had higher odds of subsequent chronic prescription opioid use, compared with a referent group that included all diagnosis types with fewer than 15 chronic opioid users, after adjusting for confounders. Conclusions By focusing interventions and prescribing guidelines on specific types of diagnoses that carry a high risk of chronic prescription opioid use and diagnoses that would benefit equally or more from alternative management approaches, states and healthcare organisations may more efficiently decrease inappropriate opioid prescribing while improving the quality of patient care
Application of a diazepam milligram equivalency algorithm to assess benzodiazepine dose intensity in Rhode Island in 2018
No full textBACKGROUND: Benzodiazepines are indicated for the treatment of many conditions, such as anxiety disorders, muscle spasms, alcohol withdrawal, agitation, movement disorders, and epilepsy, and are one of the most frequently prescribed medication classes. This class of medication has important safety considerations, including an increased risk of dependence and addiction, falls, and death from opioid overdose. Although benzodiazepine safety and prescribing encompasses a rich and important research area, there is a lack of pharmacoepidemiologic literature addressing benzodiazepine dosing intensity in real-world settings. OBJECTIVE: To develop and apply a standardized benzodiazepine milligram equivalency conversion algorithm and assess the dose intensity of benzodiazepine use in Rhode Island (RI) in 2018. METHODS: A systematic literature review was conducted to identify the most commonly used benzodiazepine equivalency values. We then conducted a cross-sectional analysis of 2018 data from the RI Prescription Drug Monitoring Program (PDMP) to calculate the mean daily diazepam milligram equivalency (DME) based on a patient\u27s most recent dispensing. A multivariable logistic regression analysis was conducted to determine the association between higher benzodiazepine doses (≥ 15 DME/day) and recipient characteristics, including concurrent use of opioids or stimulants. RESULTS: We identified 143, 026 patients who received at least 1 prescription for a benzodiazepine in RI in 2018. The mean (SD) daily DME was 10.60 (9.05), and 26.2% of individuals had a mean DME per day of at least 15. Approximately 14% (n = 20, 168) of patients prescribed a benzodiazepine had concurrent use with a prescription opioid, and 6.7% (n=9, 547) had concurrent use with a prescription stimulant. Females had a 28% lower adjusted odds of receiving a benzodiazepine dose of at least 15 DME per day compared with males (adjusted odds ratio [aOR] = 0.72, 95% CI = 0.70-0.73). The adjusted odds of receiving a benzodiazepine prescription of at least 15 DME per day was lower among the younger (aged 18-34 years) and older age groups (aged 65 years and older) compared with patients aged 35-64 years. Compared with commercial insurance, all other forms of payment had significantly higher adjusted odds of a daily benzodiazepine dose of at least 15 DME per day. The adjusted odds receiving a daily DME of at least 15 was 67% higher among those who also received a concurrent pharmacy dispensing for an opioid and 84% higher among those who also received a concurrent dispensing for a stimulant drug (aOR = 1.67, 95% CI = 1.61-1.72; aOR = 1.84, 95% CI = 1.76-1.93, respectively). CONCLUSIONS: Individuals aged 35-64 years with Medicaid insurance and those aged under 65 years with Medicare were more likely to be prescribed a benzodiazepine of at least 15 DME per day. Higher benzodiazepine DMEs were also dispensed to patients who concurrently used prescription opioids or stimulants who may be at increased risk of medication-related harm. We advocate for routine measurement of benzodiazepine dose intensity as a risk reduction strategy
Generalizing trial evidence to target populations in non-nested designs: Applications to AIDS clinical trials
Get PDFComparative effectiveness evidence from randomized trials may not be directly generalizable to a target population of substantive interest when, as in most cases, trial participants are not randomly sampled from the target population. Motivated by the need to generalize evidence from two trials conducted in the AIDS Clinical Trials Group (ACTG), we consider weighting, regression and doubly robust estimators to estimate the causal effects of HIV interventions in a specified population of people living with HIV in the USA. We focus on a non-nested trial design and discuss strategies for both point and variance estimation of the target population average treatment effect. Specifically in the generalizability context, we demonstrate both analytically and empirically that estimating the known propensity score in trials does not increase the variance for each of the weighting, regression and doubly robust estimators. We apply these methods to generalize the average treatment effects from two ACTG trials to specified target populations and operationalize key practical considerations. Finally, we report on a simulation study that investigates the finite-sample operating characteristics of the generalizability estimators and their sandwich variance estimators
The Role of School-Home Communication in Supporting the Development of Children’s and Adolescents’ Digital Skills, and the Changes Brought by Covid-19
Get PDFSchool-home communication is a growing research field in social sciences, particularly in education sciences and communication studies. While previous studies have paid much attention to the importance of school-home interaction in supporting primary academic socialisation and progress of elementary school pupils, the role of teacher-parent communication and collaboration in influencing the development of children’s and adolescents’ digital skills remains an under-researched area. This paper employed thematic analysis of in-depth interviews with education experts in six European countries, providing an insight into their opinions and views on the problems in communication between homes and schools. The analysis identified main problems in and obstacles to school-home collaboration on children’s digital skills development, and the changes the COVID-19 pandemic brought along in this field of education. The paper provides five policy recommendations for enhancing school-home collaboration on digital skills development
The Met Costume Institute: Evolution, Metamorphosis, and Cultural Phenomenon
Get PDFThe Metropolitan Museum of Art’s Costume Institute is much more than just a stagnant collection of historic dress artifacts – it’s a living, breathing cultural entity that has served as a gateway into the history of fashionable dress and accessories for men, women, and children. Unlike other museums that house these historic fashion items, the Met Costume Institute has evolved into a cultural phenomenon with its connection to Vogue, the Met Gala, and the thematic exhibitions that are displayed once or twice a year. By investigating the evolution and metamorphosis of the Met Costume Institute, this research aims to understand and identify how its exhibitions and Gala diverged from the world of staid historic costume and transformed into the mainstream cultural event that it is today. Numerous interconnected factors are applicable in having shaped this phenomenon, such as the prominence of fashion in culture, the rise of celebrity culture, and media in the digital age. This research is not only important in understanding the influence of fashion in popular media, but more specifically, in how fashion museum culture can affect the modern vernacular and behavior in society
SER-109: An Oral Investigational Microbiome Therapeutic for Patients with Recurrent Clostridioides difficile Infection (rCDI)
Get PDFClostridioides difficile infection (CDI) is classified as an urgent health threat by the Centers for Disease Control and Prevention (CDC), and affects nearly 500,000 Americans annually. Approximately 20–25% of patients with a primary infection experience a recurrence, and the risk of recurrence increases with subsequent episodes to greater than 40%. The leading risk factor for CDI is broad-spectrum antibiotics, which leads to a loss of microbial diversity and impaired colonization resistance. Current FDA-approved CDI treatment strategies target toxin or toxin-producing bacteria, but do not address microbiome disruption, which is key to the pathogenesis of recurrent CDI. Fecal microbiota transplantation (FMT) reduces the risk of recurrent CDI through the restoration of microbial diversity. However, FDA safety alerts describing hospitalizations and deaths related to pathogen transmission have raised safety concerns with the use of unregulated and unstandardized donor-derived products. SER-109 is an investigational oral microbiome therapeutic composed of purified spore-forming Firmicutes. SER-109 was superior to a placebo in reducing CDI recurrence at Week 8 (12% vs. 40%, respectively; p \u3c 0.001) in adults with a history of recurrent CDI with a favorable observed safety profile. Here, we discuss the role of the microbiome in CDI pathogenesis and the clinical development of SER-109, including its rigorous manufacturing process, which mitigates the risk of pathogen transmission. Additionally, we discuss compositional and functional changes in the gastrointestinal microbiome in patients with recurrent CDI following treatment with SER-109 that are critical to a sustained clinical response
Qualitative Analysis of Factors Supporting Child Labour Trafficking in Nigeria: Public Perceptions and Cultural Relativism
Get PDFThis study aimed to establish how socio-cultural and economic factors support the endemicity of child labour trafficking in Nigeria. The research was conducted among rural and urban households and stakeholders in southern Nigeria. A field survey was conducted in Ekiti, Edo, Kwara, Lagos, and Osun States. The study utilised cultural relativism and the margin of appreciation theories. The qualitative research approach used in-depth interviews, focus groups, and personal observation methods to collect data. Researchers interviewed 70 participants, including parents/guardians, stakeholders (government officials and private agency representatives), traffickers, trafficked children, and their employers. Societal context, especially the perception of child rights, plays an essential role in creating conditions in which child labour trafficking flourishes and constrains global efforts to eliminate the problem. Specifically, findings revealed that poverty, banditry/terrorism, religious practices, socialisation, fostering, cheap labour/urbanization, and materialism are key socio-economic factors contributing to the incidences of child labour trafficking in Nigeria. The paper concludes that international child labour trafficking continues because conditions within states maintain enabling environments for child rights violations. Consequently, understanding socio-cultural and economic contexts within states is essential to develop policies and practices that help curb or minimise the harm of international child labour trafficking
The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study
Get PDFBackground: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.
Methods: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.
Results: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.
Conclusions: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model